In June 2018, the Department of Veterans Affairs Office of Inspector General released a report detailing the VA Health Administration’s Occupational Staffing Shortages. The report describes the current state of VA Medical Centers across the United States, including self-reported disparities in staffing from the clinical and non-clinical perspectives. In addition, the report proposes to prioritize a standard medical center staffing model at the national level, with variance to compensate for diversity of individual centers at the local level. While staffing needs differed among centers, a central theme emerged throughout the report: there is a severe shortage of anesthesiologists across over 20% of the Veterans Health Administration facilities.
The importance of this statement cannot be further pronounced. As a preeminent model for providing healthcare for those who served their country, the VA Health System is a critical healthcare institution in the United States. The VA provides not only primary care, but also ancillary healthcare services such as prescription refills, mental health treatment, and minor procedures. In addition, many VA facilities are licensed to perform operative procedures, ranging from basic outpatient procedures to advanced surgeries. In these facilities, which are often located in major urban areas with a high patient volume, anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) are essential.
Anesthesia professional societies and Veterans Affairs advocacy groups alike agree that pushing for more anesthesia providers in VA hospitals is essential for providing comprehensive, specialist care. However, the policies surrounding anesthesiology are delineated and historic. In many hospitals and health centers across the United States, CRNAs are considered as highly skilled anesthesia professionals that can effectively manage the entire perioperative patient care episode. Despite the evolution of thought towards provider expertise, the VA has not yet aligned with this trend. In 2016, the VA released a policy change stating that advanced practice registered nurses would be granted full access — however, CRNAs were excluded from this ruling. The nurse subsets that were included in the full practice policy change were as follows: certified nurse practitioners (CNPs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs). Upon inquiry as to why CRNAs were not included in the policy change, the VA responded that there was not an unmet need for anesthesiology providers in their hospitals – a discussion point that is in contradiction with the recent occupational staffing reports.
The shortage of anesthesia providers is not a problem isolated to the VA. In 2010, RAND Corporation released a study predicting that the U.S. would experience a shortage of anesthesiologists by 2020 in the magnitude of tens of thousands. National news outlets and the Xenon Health blog have reported previously on the shortage of anesthesia drugs nationwide. Logically, the question arises of a potential solution to such issues. CRNAs can pose as an answer to the question of burgeoning demands for anesthesia providers. As specialized nurses, CRNAs are highly trained to manage anesthesia needs throughout the perioperative cycle. Alongside anesthesiologists, CRNAs can serve as a valuable resource for patients and fellow clinical members of the operative team, guiding care to lead patients toward the best clinical outcomes. Whether in the VA, on a national scale, or hospital-by-hospital, the need for anesthesia providers, inclusive of both anesthesiologists and CRNAs, is evident in the U.S. healthcare system.